2021 REFERENCE GUIDE RAMSEY COUNTY RETIREE BENEFIT PLAN - October 2020
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RAMSEY COUNTY
RETIREE BENEFIT PLAN
2021 REFERENCE GUIDE
October 2020TABLE OF CONTENTS
Eligibility and Enrollment ....................................................................................3
County Contributions to Retiree Medical Insurance ..........................................4
Surviving Spouse and Dependent.........................................................................5
Medicare ................................................................................................................6
Life Insurance Coverage – Early and Regular Retirees .....................................7
Dental Coverage – Early and Regular Retirees ..................................................8
Medical Coverage for Regular Retirees............................................................. 11
HealthPartners Journey and Retiree National Choice Benefit Summary ....... 16
Blue Cross Classic and Blue Cross Standard Benefit Summary ...................... 18
Medical Insurance Premiums for Regular Retirees .......................................... 21
Medical Coverage for Early Retirees................................................................. 24
Medical Insurance Premiums for Early Retirees .............................................. 26
HealthPartners Distinctions Summary of Benefits ........................................... 27
Information Contacts.......................................................................................... 29
NOTE: This Reference Guide describes the Ramsey County Retiree Insurance Plan, as it
currently exists. It is subject to change in subsequent years.
The materials describing medical and dental benefits are for informational purposes. They do not
constitute an insurance contract or policy. In any instance where there is a discrepancy between this
information and the applicable contract, the terms of that contract will apply.
Prepared by Ramsey County Human Resources Department
October 2020
2ELIGIBILITY REQUIREMENTS FOR RETIREE INSURANCE
To be eligible for Ramsey County retiree insurance benefits you must meet all of the
following:
• Be eligible to begin receiving benefits under the Public Employees Retirement Act
(PERA) at the time you retire from Ramsey County. You can qualify for PERA in
one of the following ways:
1) PERA Coordinated Plan: be at least age 55, with 5 years* of PERA service; or
2) PERA Police and Fire Plan or Correctional Plan: be at least age 50, with 5
years* of PERA service; or
3) Be at least full Social Security retirement age (some exceptions apply, see
PERA website), with 1 year of PERA service; or
4) At any age if eligible for PERA Disability Retirement, with 5 years* of PERA
service (for more information contact PERA at (651) 296-7460 or (800) 652-
9026); or
5) At any age with 30 years of service with PERA (only if you were first eligible
for PERA prior to July 1, 1989).
* Vesting requirement is 3 years if you were first eligible for PERA prior to
6/30/10.
• Be a full or part-time employee participating in and receiving County contribution to
any Ramsey County employee insurance benefit program at the time of retirement;
• Have completed the required insurance application form and provided any
documentation required by the County.
Early Retirees: Employees retiring from Ramsey County prior to age 65 are called
Early Retirees. Early Retirees must transfer to a Regular Retiree plan upon reaching age
65, or earlier, if qualified for Medicare A and B.
Regular Retirees: Retirees age 65 or older are called Regular Retirees. Disabled
retirees who have Medicare A & B are also included in this group regardless of age.
Application Process for Retiree Insurance
Eligible employees should apply for retiree insurance coverage at least 60 days prior to
retirement. Participants going from the Early Retirees' insurance plan to the Regular
Retirees' plan must also complete a new application form. This should be done at least
60 days before becoming eligible to become a Regular Retiree.
Forms are available by contacting Amber Kempe in Human Resources
121 7th Place East, Suite 2100
St. Paul, MN 55101
Telephone: 651-266-2731
3OPPORTUNITIES TO ENROLL OR MAKE CHANGES
IN MEDICAL COVERAGE
If eligible, you may enroll in or change medical coverage within 31 days of any of the
following:
• When you retire from Ramsey County.
• When you qualify for Medicare (if you qualified as a retiree for insurance
purposes when you left Ramsey County).
• When a qualifying event occurs (e.g. marriage, divorce, death, termination of
spouse's employment, losing coverage through another employer etc.), subject to
the policies, rules and regulations of the medical insurance carrier. This only
applies if you qualified as a retiree for insurance purposes when you left Ramsey
County.
Retirees who are already enrolled in medical coverage may also make changes during
the annual open enrollment period.
COUNTY CONTRIBUTION TO RETIREE
MEDICAL INSURANCE PREMIUMS
Employees eligible to participate in the retiree medical insurance plan, who were hired
prior to January 1, 2006*, may be eligible for a County contribution toward retiree
medical insurance, based on the following:
1. The defined County contribution;
2. Whether you are an Early or Regular Retiree;
3. When you retired;
4. When you were hired;
5. Length of service with the County.
*Does not apply to employees hired between July 1, 1992 and January 1, 2006, who
made the one-time election to participate in the Health Care Savings Plan and waived
eligibility for a County contribution toward retiree insurance.
Eligible employees hired on or after January 1, 2006, as well as other eligible
employees who do not meet the requirements for a County contribution, may still
participate in the Early or Regular Retiree insurance program but will pay the
entire premium for themselves and their dependents.
Defined County Contribution
The defined County contribution for Early Retirees insurance for 2021 has not yet been
set by the County Board. The current defined County contribution for 2020 is as
follows:
Early Retirees - The defined County contribution for medical insurance is the same
as the County contribution to Employee medical insurance.
4Regular Retirees (Retired prior to January 1, 1996) - The defined County
contribution is an amount not to exceed the premium for the indemnity plan
(HealthPartners Major Medical).
Regular Retirees (Retiring on or after January 1, 1996) – The defined County
contribution for medical insurance is an amount not to exceed the County
contribution for single coverage for active employees, except the retiree will pay no
less than $65 per month for single coverage; for family coverage, it is an amount not
to exceed the County contribution for family coverage for active employees, except
the retiree will pay no less than $140 per month for family coverage.
Length of Service Requirement
Employees hired before July 1, 1992, who have the hourly equivalent of 10 years
consecutive County service (20,800 hours), or five years (10,400 hours) for an
employee retiring under a PERA disability, will get the full-defined County
contribution. Those who have less than the 10-year or five-year (disabled employee)
requirement will get no County contribution.
Employees hired on or after July 1, 1992 and prior to January 1, 2006, who have
the hourly equivalent of 20 years (41,600 hours) of consecutive County employment
when they retire, will get 50% of the defined County contribution. Those with more
than 20 years will get an additional 4% per year, up to 90% of the defined County
contribution for those with 30 years or more. Those with less than 20 years will get
no County contribution.
Retiree Payment for Insurance Premiums
Retirees will be billed quarterly by Ramsey County for any health and dental premiums
required to be paid by the retirees. Due date for payment will be printed on the invoice.
You may pay either by check or by enrolling in direct debit. Retirees who are
continuing their life insurance coverage will be billed quarterly by Minnesota Life.
SURVIVING SPOUSE AND DEPENDENT BENEFITS
The surviving spouse and dependents of a deceased retiree will be permitted to continue
coverage in the plan and may be eligible for a County contribution until the spouse’s
remarriage or the dependent’s loss of dependent status. If they elect to continue, they are
permitted to participate in annual open enrollments. Health plan choices will be the
same as for other similarly situated retirees. The County contribution for the surviving
spouse and/or dependent is determined in the same way as it would have been for the
deceased retiree.
If the surviving spouse remarries, or the dependent loses dependent status, they will be
allowed to continue in the County plan subject to the terms of state and federal
continuation laws, but they will be responsible for the entire premium.
Please contact Amber Kempe of the Human Resources Department at (651) 266-2731 if
you have any questions concerning surviving spouse and dependent coverage.
5MEDICARE
Medicare is the government health insurance program for people 65 or older, or those
who qualify through a disability, that supplements the County's retiree insurance
program. The following information in this section is meant to provide a general
summary of Medicare.
You may contact Social Security with questions or for more specific information at
(800) 772-1213, between the hours of 7:00 a.m. and 7:00 p.m., Monday through Friday.
You may also visit the local Ramsey County Social Security Office located at 332
Minnesota Street, Suite N650, in downtown St. Paul.
The following websites may be helpful to you as well: www.ssa.gov and
www.medicare.gov
Medicare consists of:
Part A - Hospital insurance, which is financed by paying FICA-HI as an employee.
(Ramsey County employees who did not pay into FICA-HI, may also be entitled to
receive Medicare A if they qualify through a previous employer, or if their spouse is at
least age 62 and entitled to Medicare A at age 65). Retirees who are eligible to receive
Social Security benefits either on their own or through their spouse are not charged for
Medicare A coverage at age 65. Retirees who are ineligible for Social Security benefits
may purchase Medicare A. In 2020, the Medicare A premium is up to $458.00 per
month. The premium for 2021 has not yet been set.
Part B - Medical insurance that is financed by monthly premiums paid by those who
choose to enroll. It primarily covers physicians' services. Retirees who are 65 may enroll
in Part B even if they are ineligible for Social Security benefits. All retirees are charged
a premium for Medicare B. In 2020, the standard Medicare B premium for new
enrollees is $144.60. Some may pay higher or lower premiums depending on income.
The premium for 2021 has not yet been set.
Part C – Medicare-approved private health insurance plans (referred to as Medicare
Advantage Plans) for individuals enrolled in Original Medicare (both Part A and Part
B). When you participate in a Medicare Advantage plan, you must continue to pay your
Part B premium. Medicare Advantage plans provide all your Medicare Part A (hospital
insurance) and Medicare Part B (medical insurance) coverage. Many plans include
prescription drug coverage as well. These plans often have specific provider networks,
which mean you may have to see certain doctors and go to certain hospitals in the plan’s
network to get care. Each Medicare Advantage plan can charge different out-of-pocket
costs and have different rules for how you get services (like whether you need a referral
to see a specialist or can use only doctors, facilities, or suppliers in the network).
Part D – Medicare Prescription Drug Coverage, provided by private companies that
have been approved by Medicare. The cost of Medicare D varies depending on
insurance company and plan design. Retirees who are enrolled in the HealthPartners
6Journey, HealthPartners Retiree National Choice, the Blue Cross Classic, or the Blue
Cross Standard plans will automatically be enrolled in a corresponding Medicare Part D
plan by HealthPartners or Blue Cross. The premium for these retiree medical plans
include the cost of the Part D coverage. Some retirees may pay an additional Medicare
D Premium (deducted from their Social Security check or directly billed) depending on
income.
Retirees who are already receiving Social Security benefits prior to age 65 will
automatically receive a Medicare card in the mail prior to their 65th birthday. Retirees
who are not receiving Social Security benefits prior to age 65 must apply for Medicare
coverage. Applications should be made at the Social Security Office three months prior
to reaching age 65.
LIFE INSURANCE COVERAGE
EARLY AND REGULAR RETIREES
Early and Regular Retirees may continue their Basic and Optional Life insurance at the
group rate for 18 months following their retirement. They then have the option of either
converting or porting to other coverage (portability) without evidence of insurability.
Retirees who are continuing their life insurance coverage will be billed quarterly by
Minnesota Life.
7DENTAL COVERAGE EARLY AND REGULAR RETIREES
Dental coverage through HealthPartners Dental is only available if you were
enrolled in dental coverage as an active employee at the time you retired. Coverage
for your family is available only if you were enrolled in family coverage as an
active employee at the time of retirement. Once you terminate coverage, you
cannot re-enroll. There is no County contribution towards retiree dental
insurance.
If you are currently participating in the County’s program, you can choose between
Ramsey County Tiered Dental Network or Ramsey County Narrow Dental Network at
the time of open enrollment for insurance benefits. Each family member must
participate in the same plan as the retiree.
HEALTHPARTNERS RAMSEY COUNTY TIERED DENTAL PLAN
By choosing this plan, you have access to the largest preferred provider organization
(PPO) network of dentists in Minnesota. This plan provides the most flexibility and
national coverage in network. Choose from more than 2,700 dentists in Minnesota and
120,000 nationally. Each time you make an appointment, you or your family member
can select a dentist in any of the benefit tiers. Choosing a dentist in network provides the
most cost-effective care and provides richer benefits. There is extra coverage for
children up to age 12 called Little Partners that waives coinsurance, deductibles and
maximums for many services when in network.
• Benefit Level 1 –You have access to 27 HealthPartners Dental Group clinics in the
Twin Cities and St. Cloud area. These clinics take a preventive approach to care
assessing the risks of each patient. Frequency limits are waived at these clinics. The
annual maximum for this tier is $3,000. There is also 50% orthodontic coverage for
children (under age 19) up to $1,000 lifetime maximum per child in Benefit Level 1.
• Benefit Level 2 – This PPO Open Access network gives you access to more dental
providers than Benefit Level 1 and comes with a $1,200 annual maximum. Benefits
for tier 2 are slightly richer than the next tier plan, Benefit Level 3.
• Benefit Level 3 – Get access to a large Open Access network that provides the most
in-network dental providers.
• Non-participating dentist –You can choose to receive services from a dentist who
does not participate in the HealthPartners network. However, you pay your
coinsurance as well as the difference between what the dentist charges and the
allowable fee, which may result in significant out-of-pocket expenses. It is
recommended that your dentist submit a pre-treatment estimate for services over
$300 to HealthPartners to identify costs prior to receiving services.
8HEALTHPARTNERS RAMSEY COUNTY NARROW NETWORK PLAN
This custom network has 676 participating dentists at 306 locations throughout the state
of MN.
• There is no annual maximum or deductible in network and 50% orthodontic
coverage for children (under age 19) up to $1,000 lifetime maximum per child.
• There is extra coverage for children up to age 12 called Little Partners that waives
coinsurance and maximums for many services when in network
• For dental emergencies when traveling out of area you have coverage at the out of
network benefit level.
• Out of network benefits have an annual maximum of $1,000. There is an individual
deductible of $50 and $150 maximum for family coverage when out of network.
Preventive services are covered at 80% and the remaining services are covered at
60%.
• Orthodontic care must be provided by a contracted Orthodontist. Search the network
online or contact Member Services for network options. HealthPartners Orthodontic
clinics, Orthodontic Care Specialists and Three Rivers Orthodontic locations provide
additional discounts to HealthPartners members.
DENTAL RATES
Both Early and Regular Retirees who continue their Dental coverage must pay the full
premium. The County does not contribute to the cost of premiums for retiree dental
coverage. There is a 2% premium increase for 2021.
2021 Monthly Premium
Retiree $43.38
Retiree with Family $96.69
HealthPartners Phone Numbers
Member Services 952-883-5000 800-883-2177
9Ramsey
Dental Services Ramsey County Tiered Network Plan County
Narrow
Network Plan
Benefit Benefit Benefit Level 3 In network
Level 1 Level 2
Calendar Year Annual
Maximum – combined across $3,000 $1,200 $1,200 unlimited
all tiers
Annual Deductible none $25/ person $25/ person none
$75/ family $75/ family
Preventive/Diagnostic Care 100% 100% 100% 100%
Sealants 100% 100% 100% 100%
Basic I Services
• Fillings 100% 100% 100% 100%
• Posterior Composite 80% 80% 60% 80%
• Simple Extractions 100% 100% 100% 100%
• Non‐surgical Perio 100% 100% 100% 100%
• Endodontics 100% 100% 100% 100%
Basic II Services
Surgical Periodontics 100% 100% 100% 100%
‐ Oral Surgery 100% 100% 100% 100%
Crowns, Onlays 80% 80% 60% 60%
Prosthetics
Bridges & 50% 50% 50% 60%
Dentures
Dental Implants 50% ($1,200 50% 50% 60% ($1,200
maximum) maximum)
Orthodontics
Lifetime maximum 50% 50%
for dependents under age 19 $1,000 No coverage No coverage $1,000
(combined across networks)
This is an overview of HealthPartners coverage. Out of network coverage is also available in
both plans. For exact coverage terms and conditions consult your plan materials or call
Member Services at 952-883-5000 or 800-883-2177.
10MEDICAL COVERAGE FOR REGULAR RETIREES
There are five medical plans available to Regular Retirees in 2021:
1. HealthPartners Journey
2. HealthPartners Retiree National Choice (RNC)
3. HealthPartners Major Medical (also referred to as NationalOne)
4. Blue Cross Medicare Advantage Standard with Group Medicare Blue Rx
5. Blue Cross Medicare Advantage Classic with Rx Option 2
Plan availability for individual retirees and their spouses may be restricted based on
where they live and their eligibility for Medicare, as described below:
HealthPartners® Journey and HealthPartners® Retiree National Choice (RNC)
For 2021, HP will be offering the Medicare Group Solution, which brings together the
Journey Group Plan and Retiree National Choice Plan into one streamlined
experience. Both plans provide Part D coverage. You should not individually enroll in
a different Medicare Part D plan or you will not be eligible to participate in either Group
Plan.
The Journey Group Services Area consists of the following counties in MN: Anoka,
Becker, Beltrami, Benton, Big Stone, Carver, Cass, Chippewa, Chisago, Clay,
Clearwater, Cottonwood, Crow Wing, Dakota, Douglas, Grant, Hennepin, Hubbard,
Isanti, Jackson, Kandiyohi, Kittson, Lac qui Parle, Lake of the Woods, Lincoln, Lyon,
Mahnomen, Marshall, Morrison, Murray, Nobles, Norman, Otter Tail, Pennington,
Polk, Pope, Ramsey, Red Lake, Redwood, Renville, Roseau, Scott, Sherburne, Stearns,
Swift, Todd, Wadena, Washington, Wilkin, Wright.
The Retiree National Choice Service Area consists of the following counties in MN, the
other 49 states and Puerto Rico: Aitkin, Blue Earth, Brown, Carlton, Cook, Dodge,
Faribault, Fillmore, Freeborn, Goodhue, Houston, Itasca, Kanabec, Koochiching, Lake,
LeSueur, Martin, McLeod, Meeker, Mille Lacs, Mower, Nicollet, Olmsted, Pine,
Pipestone, Rice, Rock, Sibley, St Louis, Steele, Stevens, Traverse, Wabasha, Waseca,
Watonwan, Winona, Yellow Medicine.
You will be enrolled in the Plan based on your county of residence. Retirees and
spouses must have Medicare A & B.
Retirees in either plan can see any Medicare provider. The Journey Group plan has a
network that includes all major care groups. Plus, there is no additional cost-sharing for
out-of-network providers. That means retiree members pay the same cost-sharing
whether they see in-network or out-of-network providers under the Journey Group
plan. For information about the Journey network, call HealthPartners Member Services
at (952) 883-7979. The Retiree National Choice plan can see any provider that accepts
Medicare.
11The Plan provides 100% coverage for preventive health care; a $30 office visit copay
($15 for convenience care clinics) for services received from a network physician for
illness or injury and includes chiropractic care; unlimited free visits to Virtuwell,
HealthPartners 24/7 on-line clinic; a $35 copay for urgent care visits within the network;
a $75 copay for emergency room visits; and 100% coverage for inpatient care after a
$75 copayment. Outpatient surgery is subject to a $75 copay. Outpatient services are
covered at 100%. MRI/CT scans are covered at 90% with the member paying a co-
insurance of 10%. This plan also provides preventative dental coverage with a $15 co-
pay. The maximum out-of-pocket cost for medical care is $1,100 per person.
Prescription coverage provides for a $12 copay for preferred generic prescriptions; a
$17 copay for non-preferred generic prescriptions; a $30 copay for preferred brand
prescriptions; a $35 copay for non-preferred brand prescriptions and a $40 copay for
specialty tier formulary prescriptions. Journey Plan members can utilize the mail order
pharmacy benefit to obtain a 3-month supply of eligible prescription drugs for two
copays for most medications. There is no out-of-pocket maximum for prescriptions.
As either a Journey or Retiree National Choice member, you’ll have access to
Silver&Fit® Exercise & Healthy Aging Program. This program offers membership at a
participating fitness facility. There is no fee for Silver&Fit®. If you prefer to work out
at home, you can choose the free Home Fitness Program. Visit silverandfit.com to
locate participating facilities.
If a spouse or dependent child of a HealthPartners Journey or Retiree National Choice,
retiree is not Medicare-eligible, they would be enrolled in the HealthPartners
Distinctions plan for employees and Early Retirees. Please see the enclosed summary in
the Early Retiree section of this Reference Guide for a more complete description of
plan benefits.
Please see the enclosed summary beginning on page 16 for a more complete description
of plan benefits.
HealthPartners Major Medical Plan (also called NationalOne)
The HealthPartners Major Medical plan will continue to be offered in 2021.
Participation in the plan is limited to Regular Retirees who are ineligible for
Medicare Part A along with their families. Regular Retirees who are ineligible for
Medicare Part A, may choose to enroll in Medicare Part B, as it may be financially
advantageous. Retirees can contact Social Security at (800) 772-1213, Monday-Friday,
7:00 a.m. to 7:00 p.m., or visit their website at www.ssa.gov for more specific
information.
Please contact Amber Kempe at (651) 266-2731 if you are ineligible for Medicare Part
A and have further questions about the benefits of this plan.
12Blue Cross and Blue Shield of Minnesota Group Medicare Advantage Standard
(MA-only PPO) with Group MedicareBlue Rx (PDP).
The Blue Cross Group Medicare Advantage Standard (MA-only PPO) with Group
MedicareBlue Rx (PDP) is a Medicare-approved Medicare Advantage plan and a stand-
alone Medicare Part D prescription drug plan. They are packaged together to form a
comprehensive insurance option for eligible Ramsey County retirees.
Retirees and any eligible dependents must have Medicare A & B and reside in the 66
county Minnesota area to participate in this plan. A complete listing of eligible
counties is available on page 20. Please note that Group MedicareBlue Rx is a
Medicare Part-D plan. Retirees who enroll in the County’s Blue Cross plan should not
individually enroll in a different Medicare Part D plan or you will not be able to
participate in this plan.
To receive in-network medical benefits within Minnesota, members must use the Group
Medicare Advantage provider network. Members may travel outside of Minnesota for
up to nine months within the United States and receive plan benefits at the in-network
level, provided they use a Medicare contracted provider who accepts assignment or is a
Blue Card PPO Network provider. The MedicareBlue Rx pharmacy network includes
over 65,000 pharmacies nationwide. For information on the Group Medicare
Advantage provider network in Minnesota, or the MedicareBlue Rx pharmacy network,
call the Pre-enrollment Call Center at 1-888-870-6296.
The Blue Cross plan provides 100% coverage for preventive health care. There is a $20
office visit co-payment for services received from a network physician (including
convenience care clinics) for illness or injury, and a $20 co-payment for urgent care
visits within the network. Inpatient care has a $200 co-payment, outpatient surgery a
$75 co-payment, and MRI/CT scans are covered at 100%. There is a $50 co-payment
for emergency room visits and ambulance service is covered with a $75 co-payment.
The maximum out-of-pocket cost for in-network medical care, and care provided by the
Travel Benefit, is $3,000 per person per calendar year for medical only.
The Group MedicareBlue Rx plan uses a Medicare approved formulary for covered
drugs. The benefit provides for a $10 co-payment for generic drugs, a $30 co-payment
for preferred brand-name, a $50 co-payment for non-preferred brand and a $30 co-
payment for specialty tier drugs. Members can obtain up to a 90-day supply of eligible
prescription drugs for two co-payments through the mail order program or any
participating retail pharmacy. There is no out-of-pocket maximum cost for
prescriptions. However, enrollees in the Group MedicareBlue Rx plan have Medicare
Part D Catastrophic Coverage which applies when out of pocket costs combined with
manufacturer discounts reach $6,550. Once in Catastrophic Coverage, you will pay the
greater of: $3.70 copay for a generic drug or a drug that is treated like a generic, and
$9.20 copay for all other drugs, or 5% of the drug cost up to an amount not to exceed
13your initial prescription copays of $10 for generic, $30 for preferred brand-name, $50
for non-preferred brand-name and $30 for specialty drugs.
Blue Cross and Blue Shield of Minnesota Group Medicare Advantage Classic with
Rx Option 2 (MAPD-PPO) .
The Blue Cross Group Medicare Advantage Classic with Rx Option 2 is a Medicare-
approved Advantage plan, combined with a built-in Medicare Part D prescription drug
plan. Retirees and any eligible dependents must have Medicare A & B, and reside in
the 66 county Minnesota area to participate in this plan. A complete listing of eligible
counties is available on page 20. Retirees who enroll in the County’s Blue Cross
plan should not individually enroll in a different Medicare Part D plan or you will not
be eligible to participate in this plan.
To receive in-network medical benefits within Minnesota, members must use the Group
Medicare Advantage provider network. Members may travel outside of Minnesota for
up to nine months within the United States and receive plan benefits at the in-network
level, provided they use a Medicare contracted provider who accepts assignment or is a
Blue Card PPO Network provider. The Rx option 2 Part D pharmacy network includes
over 64,000 pharmacies nationwide. For information on the Group Medicare
Advantage provider network in Minnesota, or the pharmacy network, call the Pre-
enrollment Call Center at 1-888-870-6296.
The Blue Cross plan provides 100% coverage for preventive health care. There is a $10
office visit co-payment for services received from a primary network physician
(including convenience care clinics) for illness or injury, a $40 office visit co-payment
for specialty office visits, and a $45 co-payment for urgent care visits within the
network. Inpatient care has a $300 co-payment, outpatient hospital surgery a $300 co-
payment and $200 copayment for ambulatory surgical center, and MRI/CT scans are
covered at 80% with the member paying a co-insurance of 20%. There is a $90 co-
payment for emergency room visits and ambulance service is covered with a $250 co-
payment. The maximum out-of-pocket cost for in-network medical care, and care
provided by the Travel Benefit, is $3,900 per person per calendar year for medical only.
The Group Medicare Advantage plan uses a Medicare approved formulary for covered
drugs. The benefit provides for a $1 co-payment for preferred generic, $10 co-payment
for generic drugs, a $25 co-payment for preferred brand-name, a $60 co-payment for
non-preferred drugs and 25% coinsurance for specialty tier drugs. Members can obtain
up to a 90-day supply of eligible prescription drugs for two co-payments or coinsurance
through the mail order program or any participating retail pharmacy. There is no out-of-
pocket maximum cost for prescriptions. However, enrollees in the Group Medicare
Advantage Classic plan have Medicare Part D Catastrophic Coverage which applies
when out of pocket costs combined with manufacturer discounts reach $6.550. Once in
Catastrophic Coverage, you will pay the greater of: $3.70 copay for a generic drug or a
drug treated like a generic, and $9.20 copay for all other drugs, or 5% of the drug cost
14As a Blue Cross member under either plan, you'll have access to SilverSneakers®
fitness membership. Get access to more than 16,000 SilverSneakers fitness locations
including gyms, and community and senior centers. Plus, get on-demand workout
videos and fitness classes, all at no additional cost to you. Visit silversneakers.com for
more details.
Please see the enclosed summary for a more complete description of plan benefits.
SilverSneakers is a registered trademark of Tivity Health, Inc. SilverSneakers On-Demand and
SilverSneakers GO are trademarks of Tivity Health, Inc. © 2019 Tivity Health, Inc. All rights reserved.
1522021 Ramsey County
HealthPartners Retiree Plan Options
This is a brief overview of plan benefits prepared by Ramsey County. Your 2021
HealthPartners Group Certificate or Schedule of Payments will provide more complete
information. You may also call Member Services at (952) 883-7979 or 800-233-9645. TDD
(952) 883-6060 or 800-443-0156.
019 GROUP MEDICARE PLAN COMPARISON
HealthPartners Retiree
Benefit/Service within U.S. HealthPartners Journey
National Choice
Ramsey County
Lifetime maximum Unlimited Unlimited
Annual out-of-pocket maximum $1,100 (Medical only) $1,100 (Medical Only)
Preventive Health Care
Routine physical, eye & hearing 100% coverage 100% coverage
exams
Immunizations 100% coverage 100% coverage
Office Visits
For illness or injury—including $30 copay $30 copay
Chiropractic and Mental Health
E-visits 100% coverage 100% Coverage
Inpatient Hospital Care
For illness or injury—including $75 per benefit period $75 per benefit period
Mental and Chemical Health
Skilled nursing facility 100% coverage 100% coverage
Emergency Care
Emergency room in the U.S. $75 copay $75 copay
Urgently needed care in the U.S. $35 copay $35 copay
Ambulance in the U.S. 100% coverage 100% coverage
Emergency and Urgently needed 80% coverage 80% coverage
care outside the U.S.
Outpatient Medical Services and
Supplies
Outpatient Surgery $75 Copay $75 Copay
Outpatient Services 100% 100%
Physical/occupational therapy 100% coverage 100% coverage
Speech/language therapy $30 copay $30 copay
Durable medical equipment— 90% coverage 90% coverage
includes Prosthetics and Diabetic
Diabetes self-monitoring training, 100% coverage 100% coverage
nutrition therapy
Diagnostic tests, radiology, lab 100% coverage 100% coverage
services
MRI/CT Scans 90% coverage 90% coverage
16HealthPartners Retiree
Benefit/Service within U.S. HealthPartners Journey
National Choice
Drug Benefit, Retail Pharmacy to
$6,550
Preferred Generic drugs $12 copay/one month $12 copay/one month
supply supply
Generic Drugs $17 copay $17 copay
Preferred brand drugs $30 copay $30 copay
Non-preferred brand drugs $35 copay $35 copay
Specialty drugs $40 copay $40 copay
Catastrophic coverage You pay the greater of: You pay the greater of:
After total out-of-pocket costs $3.70 copay for generic $3.70 copay for generic
reach $6,550 formulary drugs, $9.20 formulary drugs, $9.20
copay for brand formulary copay for brand formulary
drugs, or 5% of the drug drugs, or 5% of the drug
cost, not to exceed your cost, not to exceed your
usual copays or usual copays or
coinsurance. coinsurance.
Other
Medicare Part B drugs 80% coverage 80% coverage
Preventive Dental $15 copay for 2 cleanings, 2 $15 copay for 2 cleanings, 2
exams, 1 x-ray exams, 1 x-ray
$199/$499 copay based on $199/$499 copay based on
Hearing aids hearing aid options through hearing aid options through
TruHearing TruHearing
172021 GROUP MEDICARE PLAN COMPARISON
Ramsey County
Group Medicare Advantage Group Medicare Advantage
Standard (MA-only PPO) with Classic with Rx Option 2
Plan Coverage
Group MedicareBlue Rx (MAPD-PPO)
(PDP)
Medical + Medicare Part D Medical and Part D combined
Plan 66 MN counties
66 MN counties
You must continue to pay
your Medicare Part B
premium
Plan descriptions A Medicare Advantage plan A Medicare Advantage plan
and a Medicare Part D that includes Medicare Part D
prescription drug plan prescription drug coverage
Residency requirements Group Medicare Advantage Group Medicare Advantage
Plan: Plan:
Must be a permanent resident Must be a permanent resident
in the 66-county Minnesota in the 66-county Minnesota
Service Area. Service Area.
Group MedicareBlue Rx:
Must be a permanent resident
of the United States
Provider networks Group Medicare Advantage Group Medicare Advantage
Plan: Plan:
Group Medicare Advantage Group Medicare Advantage
network in Minnesota; outside network in Minnesota; outside
the service area, within the the service area, within the
United States, you may travel United States, you may travel
up to 9 months and receive in- up to 9 months and receive in-
network plan benefits from any network plan benefits from any
Medicare contracted provider. Medicare contracted provider.
Group MedicareBlue Rx: Medicare Part D:
Over 65,000 pharmacies Access to over 64,000
nationwide pharmacies nationwide
Individual Lifetime None None
Maximum
Deductible None None
Out of pocket maximum $3,000 in-network $3,900 in-network
Medical only $3,000 in-network and out-of- $6,100 in-network and out-of-
network combined network combined
18Group Medicare Advantage Group Medicare Advantage
Medical Coverage Standard (MA-only PPO) with Classic with Rx Option 2
Group MedicareBlue Rx (PDP) (MAPD-PPO)
Office visits
Primary care/specialist visits $20 copay Primary care: $10 copay
Specialty care: $40 copay
Chiropractic care $20 copay $20 copay
(manual manipulation of the
spine)
Inpatient care
Hospital care $200 copay $300 copay
Skilled nursing facility 100% coverage 100% coverage
Outpatient care
Ambulatory surgery center $75 copay $200 copay
Diagnostic tests, X-rays, and 100% coverage 20% coinsurance
lab services $0 copay labs
Physical, speech, and $20 copay $30 copay
occupational therapy
Home health care 100% coverage 100% coverage
Emergency/Urgent care
Emergency care $50 copay $90 copay
Urgent care $20 copay $45 copay
Ambulance service $75 copay $250 copay
Other outpatient services
Certain outpatient prescription 20% coinsurance 20% coinsurance
drugs covered under
Medicare Part B
Durable medical equipment 20% coinsurance 15% coinsurance
Diabetic supplies (includes 100% coverage 100% coverage
test strips, lancets)
Preventive care
Annual routine physical, eye 100% coverage 100% coverage
exam, and hearing screening
Additional services and 24-hour Nurse Line, 24-hour Nurse Line,
support SilverSneakers® fitness SilverSneakers® fitness
membership, membership,
$150 annual eyewear benefit, $150 annual eyewear benefit,
$499 Advanced Aid -$799 $499 Advanced Aid -$799
Premium Aid hearing aid benefit, Premium Aid hearing aid
$50 quarterly over-the-counter benefit,
allowance, $50 quarterly over-the-counter
Meal benefit that provides up to 2 allowance,
meals a day for up to 28 days Meal benefit that provides up
following a qualified inpatient to 2 meals a day for up to 28
hospital stay, days following a qualified
Doctor on Demand inpatient hospital stay,
Doctor on Demand
19Group MedicareBlue Rx Medicare Part D coverage
(PDP) $1/$10/$25/$60/
Prescription Drug Coverage
$10/$30/$50/$30 (CAP) 25% coinsurance
Medicare Part D
Up to 31-day supply
Up to 30-day supply
No deductible and no Tier 1: Generic drugs $10 Tier 1: Preferred generic
coverage gap copay drugs – $1 copay
Tier 2: Preferred brand Tier 2: Generic drugs- $10
90-day supply: drugs $30 copay copay
Two copays or 25% Tier 3: Non-preferred Brand Tier 3: Preferred brand
coinsurance by mail order or drugs $50 copay drugs- $25 copay
at a preferred extended Tier 4: Specialty drugs $30 Tier 4: Non-preferred drugs-
supply retail pharmacy copay $60 copay
Tier 5: Specialty drugs- 25%
coinsurance
Supplemental Drug Supplemental Drug
Coverage: 25% coinsurance Coverage: 25% coinsurance
for certain sexual dysfunction for certain sexual dysfunction
and cough and cold products and cough and cold products
Coverage Gap Same tier copays/coinsurance Same tier copays/coinsurance
After yearly drug costs reach you pay above you pay above
$4,130
Catastrophic coverage You pay the greater of: You pay the greater of:
After total out-of-pocket costs $3.70 copay for a generic drug $3.70 copay for a generic drug
reach $$6,550 or a drug that is treated like a or a drug that is treated like a
generic, and $9.20 copay for generic, and $9.20 copay for
all other drugs, or 5% of the all other drugs, or 5% of the
drug cost, not to exceed your drug cost.
usual copays or
coinsurance.
Blue Cross offers Medicare Advantage and Medicare Part D PDP plans with Medicare
contracts. Enrollment in these plans depends on renewal of the plan sponsor's Medicare
contract. Limitations, copayments, and restrictions may apply. You may also refer to the
Summary of Benefits documents provided in your enrollment kit.
Group Medicare Advantage Service Area (66 county): Anoka, Becker, Beltrami, Benton,
Big Stone, Blue Earth, Brown, Carver, Cass, Chippewa, Chisago, Clay, Clearwater,
Cottonwood, Crow Wing, Dakota, Dodge, Douglas, Faribault, Fillmore, Freeborn, Grant,
Hennepin, Houston, Hubbard, Isanti, Jackson, Kandiyohi, Kittson, Lac Qui Parle, Lake of the
Woods, Lincoln, Lyon, Mahnomen, Marshall, Martin, Morrison, Mower, Murray, Nicollet,
Nobles, Norman, Olmsted, Otter Tail, Pennington, Polk, Pope, Ramsey, Red Lake, Redwood,
Renville, Roseau, Scott, Sherburne, Stearns, Steele, Swift, Todd, Wabasha, Wadena,
Waseca, Washington, Watonwan, Wilkin, Winona, Wright.
20Monthly Medical Insurance Premiums for Eligible Regular Retirees
Eligible Regular Retirees who retired prior to January 1, 1996
The County and Retiree contributions for medical insurance listed below are for 2020.
The County and Retiree contributions for 2021 have not yet been set by the County Board.
2021 Total 2020 Total 2020 Defined 2020 Retiree
HealthPartners Journey Rate Rate County Pays
Contribution
Single $284.70 $284.77 $284.77 $0
Retiree & Spouse, both with Medicare A&B $569.40 $569.54 $569.54 $0
Retiree & Spouse without Medicare $1,221.89 $1,163.08 $1,163.08 $0
Retiree & Spouse w/o Medicare plus $1,581.04 $1,499.66 $1,499.66 $0
children
Retiree & Spouse with Medicare plus one $928.55 $906.12 $906.12 $0
child
Retiree & Spouse with Medicare and
two or more children $1,287.70 $1,242.70 $1,242.70 $0
HealthPartners National Choice
Single $284.70 $341.05 $341.05 $0
Retiree & Spouse, both with Medicare A&B $569.40 $682.10 $682.10 $0
Retiree & Spouse without Medicare $1,221.89 $1,219.36 $1,219.36 $0
Retiree & Spouse w/o Medicare plus $1,581.04 $1,555.94 $1,555.94 $0
children
Retiree & Spouse with Medicare plus one $928.55 $1,018.68 $1,018.68 $0
child
Retiree & Spouse with Medicare and
two or more children $1,287.70 $1,355.26 $1,355.26 $0
HealthPartners Major Medical (limited to
Retiree 65 and over WITHOUT Medicare)
Single $836.62 $784.06 $784.06 $0
Family $1,675.67 $1,570.39 $1,570.39 $0
Blue Cross Medicare Advantage Classic
PPO with Rx Option 2 Part D
Retiree $206.00 $209.50 $209.50 $0
Retiree & Spouse, both with Medicare $412.00 $419.00 $419.00 $0
Blue Cross Medicare Advantage Standard with
Group Medicare Blue Rx
Retiree $267.00 $291.50 $291.50 $0
Retiree & Spouse, both with Medicare $534.00 $583.00 $583.00 $0
All the County contributions listed above are subject to the date of hire and length of service provisions
established by previous County Board resolutions.
Dental Rates – see Dental Section
21Monthly Medical Insurance Premiums for Eligible Regular Retirees
Eligible Regular Retirees Hired Prior to 7/1/92 and retired in or after 1996
The County and Retiree contributions for medical insurance listed below are for 2020.
The County and Retiree contributions for 2021 have not yet been set by the County Board.
2021 Total 2020 Total 2020 Defined 2020 Retiree
Rate Rate County Pays
Contribution
SINGLE Coverage
HealthPartners Journey $284.70 284.77 $219.77 $65.00
HealthPartners Retiree National Choice $284.70 $341.05 $276.05 $65.00
HealthPartners Major Medical* $836.62 $784.06 $719.06 $65.00
Blue Cross Medicare Classic PPO with Rx
Option 2 Part D $206.00 $209.50 $144.50 $65.00
Blue Cross Medicare Advantage Standard with
Group Medicare Blue Rx $267.00 $291.50 $226.50 $65.00
FAMILY Coverage
HealthPartners
HealthPartners Journey
Retiree + Spouse, both with Medicare A&B $569.40 $569.54 $429.54 $140.00
Retiree + Spouse without Medicare $1,221.89 $1,163.08 $1,023.08 $140.00
Retiree + Spouse without Medicare + children $1,581.04 $1,499.66 $1,359.66 $140.00
Retiree + Spouse with Medicare + child $928.55 $906.12 $766.12 $140.00
Retiree + Spouse with Medicare + children $1,287.70 $1,242.70 $1,102.70 $140.00
HealthPartners National Choice
Retiree + Spouse, both with Medicare A&B $569.40 $682.10 $542.10 $140.00
Retiree + Spouse without Medicare $1,221.89 $1,219.36 $1,079.36 $140.00
Retiree + Spouse without Medicare + children $1,581.04 $1,555.94 $1,415.94 $140.00
Retiree + Spouse with Medicare + child $928.55 $1,018.68 $878.38 $140.00
Retiree + Spouse with Medicare + children $1,287.70 $1,355.26 $1,215.26 $140.00
HealthPartners Major Medical* $1,675.67 $1,570.39 $1,430.39 $140.00
Blue Cross Medicare Advantage Classic PPO $412.00 $419.00 $279.00 $140.00
with Rx Option 2 Part D
Blue Cross Medicare Advantage Standard with $534.00 $583.00 $443.00 $140.00
Group Medicare Blue Rx
*This plan is limited to Regular Retirees without Medicare
All the County contributions listed above are subject to the date of hire and length of service provisions
established by previous County Board resolutions.
Dental Rates – see Dental Section
22Monthly Medical Insurance Premiums for Eligible Regular Retirees
Hired on or after 7/1/1992 and prior to 1/1/2006
The County and Retiree contributions for medical insurance listed below are for 2020. The County
and Retiree contributions for 2021 have not yet been set by the County Board.
Employees who have the hourly equivalent of 20 years’ consecutive county employment will receive
50% of the defined county contribution amount as shown in bold on the previous table for Regular
Retirees hired prior to 7/1/92 (see the table column labeled “Defined County Contribution” on the
previous page). Those with more than 20 years will get an additional 4% per year in County
contribution added to the 50% base rate, up to a maximum of 90%. Those with less than 20 years will
not get any County Contribution.
2021 Total 2020 Total 2020 County 2020 Retiree
Examples Rate Rate Contribution Pays
Single Coverage
(using 20 years of service: 50%)
Blue Cross Advantage Classic $206.00 $209.50 $72.25 $137.25
$144.50 x 50%
Family Coverage
Spouse without Medicare
(using 21 years of service: 50% +
4%)
HealthPartners Journey $1,221.89 $1,163.08 $552.46 $610.62
$1,023.08 x .54
The preceding examples are for illustration only. Your situation may be different. To calculate your
expected County Contribution rate, start with a 50% base ratio for your first 20 years of service (if less
than 20 years of service, you will not receive a County contribution towards your health insurance
premium), add 4% for each additional year of service, and multiply that total against the Defined
County Contribution amount for the insurance plan you selected as shown in the table for Regular
Retirees hired before 7/1/92 and retired in or after 1996.
Please call Amber Kempe in Human Resources at (651) 266-2731 if you need assistance in
determining the premium rate for your circumstances.
Eligible employees hired on or after January 1, 2006, as well as other eligible employees who do
not meet the requirements for a County contribution, may still participate in the Early or
Regular Retiree insurance program but will pay the entire premium for themselves and their
dependents.
All the County contributions listed above are subject to the date of hire and length of service
provisions established by previous County Board resolutions.
Dental Rates – see Dental section
23MEDICAL COVERAGE FOR EARLY RETIREES
HEALTHPARTNERS DISTINCTIONS (GROUP #12900)
Medical coverage is available to you, or to you and your family through the
HealthPartners Distinctions plan. It is the same plan in which active employees
participate. You must have coverage on yourself to cover your dependents.
Dependent children may be covered up to age 26 regardless of student status, place of
residence, or marital status.
This plan provides in-network and out-of-network coverage. To obtain in-network
benefits, you may obtain services from any network provider. The large, open-
access network is split into two benefit levels based on provider cost and quality.
You do not need to select a primary care clinic, and you do not need referrals to see
in-network specialists. You generally have richer benefits when you use providers
in Benefit Level One than when you use providers in Benefit Level Two.
In-network benefits: There is an annual in-network deductible (not applicable to
preventive care or prescriptions) of $25 per person/$75 per family. Preventive
health care is covered at 100% in both Benefit Level One and Two. If you (and your
spouse if carrying family coverage) complete the HealthPartners Healthy Benefits
program, your office visit copay to see a Benefit Level One provider for illness or
injury is $25; to see a Benefit Level Two provider is $40. Your co-pay if you visit a
convenience clinic is $10. If you (or your spouse if carrying family coverage) do not
complete the HealthPartners Healthy Benefits program, your office visit co-pay to
see a Benefit Level One provider for injury or illness is $45; to see a Benefit Level
Two provider is $60. Your co-pay if you visit a convenience clinic is $20. Urgent
care is covered at the Benefit Level Two cost; emergency care is covered at 100%
after $100 co-pay. You will have access to Virtuwell, HealthPartners 24/7 on-line
clinic, for 3 free visits per person, per year. Additional visits are covered at the
convenience clinic co-pay level.
The inpatient hospital care co-pay for a Benefit Level One provider is $125 per
admit; for a Benefit Level Two provider, the co-pay is $275 per admit. The
Outpatient care co-pay for a Benefit Level One provider is $125 per year; for a
Benefit Level Two provider, the co-pay is $275 per year. There is an annual
medical out-of-pocket maximum of $1,200 per person/$2,400 per family and a
separate annual prescription drug out-of-pocket maximum of $1,200 per
person/$2,400 per family. The co-pay for formulary prescriptions for a one-month
supply is $12 for generic and $35 for brand. The mail order pharmacy benefit is
available to obtain a three-month supply of eligible prescription drugs for two co-
pays.
24HEALTHPARTNERS DISTINCTIONS (GROUP #12900) cont.
Out-of-network benefits: For Emergency Room, Urgent Care and Emergency Medical
Transportation services the out-of-network benefit is the same as the in-network benefit.
For non-emergency care, inpatient and outpatient care are generally covered at 65% (of
the usual and customary charges recognized by HealthPartners) after you have met your
deductible of $750 per person or $2,100 per family.
Costs incurred in excess of the usual and customary level are the responsibility of the
member (balance billing) and do not count toward the out-of-pocket maximum. The out-
of-pocket maximum for eligible out-of-network medical expenses is $3,500 per
person/$8,500 per family.
Summary of Benefits Coverage: A detailed Summary of Benefits Coverage (SBC) is
available at www.ramseycounty.us/OpenEnrollment . If you require a paper copy, you
may contact our office.
Important information for out-of-area retirees or dependents: HealthPartners
contracts with CIGNA Healthcare to provide services to HealthPartners members
outside of the HealthPartners service area. CIGNA is a national network of over
700,000 providers. When Distinctions members use the CIGNA network, their
claim will be processed as an in-network, Benefit Level Two claim. This provides a
valuable benefit for Early Retirees or school-aged dependents who reside outside of
the service area. If you need help finding a CIGNA provider, call (952) 883-5000 or
(800) 883-2177, or go to www.healthpartners.com.
Spouse with Medicare
If you are an Early Retiree and you choose to cover your spouse who has Medicare A
& B, your spouse must enroll in one of the HealthPartners Medicare plans. (See the
Regular Retiree section of this Reference Guide for plan descriptions.) Your spouse
should not enroll in a separate Medicare Part D plan. Please call Amber Kempe in
Human Resources at (651) 266-2731 to discuss your options.
Waiver of Deductible for Dependent Children
The out-of-network deductible ($750) is waived for dependent children residing outside
the HealthPartners network of participating providers. You must complete a ‘Certificate
of Dependent Status’ form each year. Forms are available by calling Human Resources
at (651) 266-2731 or (651) 266-2923.
Provider Information
The most current provider information is available on the HealthPartners website
(www.healthpartners.com), or you may contact HealthPartners Member Services at
(952) 883-5000.
25Monthly Medical Insurance Premiums for Eligible Early Retirees Hired prior to 7/1/92
The County and Retiree contributions for medical insurance listed below are for 2020. The County
and Retiree contributions for 2021 have not yet been set by the County Board.
2021 Total 2020 Total 2020 County 2020 Retiree
Rate Rate Contribution Pays
Single $937.19 $878.31 $808.31 $70.00
Family $2,233.53 $2,093.20 $1,562.40 $530.80
Family (Spouse with Medicare A&B under
Journey Plan) $1,221.89 $1,163.08 $1,023.08 $140.00
Family (Spouse with Medicare A&B and one
or more children under the Journey Plan) $1,581.04 $1,499.66 $1,359.66 $140.00
Family (Spouse with Medicare A&B under
National Choice Plan) $1,221.89 $1,219.36 $1,079.36 $140.00
Family (Spouse with Medicare A&B and one
or more children under the National Choice $1,581.04 $1,555.94 $1,415.94 $140.00
Plan)
Monthly Medical Insurance Premiums for Eligible Early Retirees
Hired on or after 7/1/1992 and prior to 1/1/2006
The County and Retiree contributions for medical insurance listed below are for 2020. The County
and Retiree contributions for 2021 have not yet been set by the County Board.
Employees who have the hourly equivalent of 20 years’ consecutive county employment will receive
50% of the defined county contribution amount as shown in bold on the previous table for Early
Retirees hired prior to 7/1/92 (see the table column labeled “Defined County Contribution” above).
Those with more than 20 years will get an additional 4% per year in County contribution added to the
50% base rate, up to a maximum of 90%. Those with less than 20 years will not get any County
Contribution.
2021 2020 Total 2020 County 2020 Retiree
Examples Total Rate Rate Contribution Pays
Single Coverage $937.19 $878.31 $404.16 $474.15
(using 20 years of service: 50% $808.31 x .50
Family Coverage $1,221.89 $1,163.08 $552.46 $610.62
Spouse w/ Medicare under Journey $1,023.08 x .54
(using 21 years of service: 50% + 4%)
The preceding examples are for illustration only. Your situation may be different. To calculate your
expected County Contribution rate, start with a 50% base rate for your first 20 years of service (if less
than 20 years of service, you will not receive a County contribution towards your health insurance
premium), add 4% for each additional year of service, and multiply that total against the Defined
County Contribution amount for the insurance plan you selected as shown in the table for Eligible
Early Retirees hired before 7/1/92.
Please call Amber Kempe in Human Resources at (651) 266-2731 if you need assistance in
determining the premium rate for your circumstances.
All the County contributions listed above are subject to the date of hire and length of service
provisions established by previous County Board resolutions.
Dental Rates - see dental section
26HealthPartners
DistinctionsSM II Ramsey County 2021
The following is an overview prepared by Ramsey County. For exact coverage terms, and conditions, consult
your plan materials available through HealthPartners Member Services at (952) 883-5000 or 1-800-883-2177.
Plan highlights In-network Out-of-network
Care from an out-of-network
Partial listing of covered services Care from a network provider provider
Deductible and Out-of-Pocket
Lifetime maximum Unlimited $1,000,000
Calendar year deductible $25 per person; $75 per family $750 per person; $2,100 per
family
Calendar year medical out-of- $1,200 per person; $2,400 per family $3,500 per person; $8,500 per
pocket maximum family
Calendar year prescription out-of- $1,200 per person; $2,400 per family, combined for in-network and out-of-network
pocket maximum
Preventive Health Care
Routine physical & basic eye 100% coverage No Coverage
examinations, well-child care
Prenatal and postnatal care 100% coverage You pay 35% after deductible
Immunizations 100% coverage No Coverage
Office Visits
Illness or injury Healthy Benefits: You pay 35% after deductible
- $25 Benefit Level 1 after deductible
- $40 Benefit Level 2 after deductible
No Healthy Benefits:
- $45 Benefit Level 1 after deductible
- $60 Benefit Level 2 after deductible
Allergy Injections and all other $2 per visit after deductible You pay 35% after deductible
injections in a physician’s office
Physical, occupational and speech Healthy Benefits: You pay 35% after deductible
therapy - $25 Benefit Level 1 after deductible
- $40 Benefit Level 2 after deductible
No Healthy Benefits:
- $45 Benefit Level 1 after deductible
- $60 Benefit Level 2 after deductible
Chiropractic care Healthy Benefits: $40 after deductible You pay 35% after deductible
(neuromusculo-skeletal conditions only) No Healthy Benefits: $60 after deductible 20 visits per calendar year
Mental health care Healthy Benefits: $25 after deductible You pay 35% after deductible
No Healthy Benefits: $45 after deductible
Chemical health care Healthy Benefits: $25 after deductible You pay 35% after deductible
No Healthy Benefits: $45 after deductible
Convenience Care
Convenience clinics (retail clinics), Healthy Benefits: $10 after deductible You pay 35% after deductible
eVisits; if using Virtuwell the first No Healthy Benefits: $20 after deductible
three visits free
Outpatient Care
Scheduled outpatient procedure Benefit Level 1 - $125 per year after deductible You pay 35% after deductible
Benefit Level 2 - $275 per year after deductible
Outpatient MRI and CT Scan You pay 20% after deductible You pay 35% after deductible
Emergency Care
Urgently needed care at an urgent Healthy Benefits: $40 after deductible HealthPartners in-network benefit
care clinic or medical center No Healthy Benefits: $60 after deductible
Emergency care at a hospital ER $100 co-payment per visit after deductible HealthPartners in-network benefit
Ambulance You pay 20% after deductible HealthPartners in-network benefit
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